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Co-Occurring PTSD and Substance Use

Post-Traumatic Stress Disorder is an anxiety-based mental health condition that follows the occurrence of a traumatic event. Though the co-occurrence of substance abuse is frequent among these individuals, studies have shown that men are more likely to develop both conditions than women are. Approximately 35% of men who struggle with PTSD also develop a substance use disorder compared to only 18% of women.

Why PTSD and Substance Misuse Co-Occur

There is not one sole reason why men and women who suffer from PTSD develop a drug or alcohol addiction. The causes, durations, and intensity of these co-occurrences depend entirely on the individual person, their specific trauma, and the genetics that makes up their predisposition to certain disorders. In order to be diagnosed with PTSD, a person must experience symptoms for longer than one month following a traumatic event, and those symptoms must negatively impact the person’s life, relationships, and work without being related to drugs, alcohol, or other illnesses. Because of these requirements, we know that PTSD must precede the development of a substance use disorder.

Individuals will experience a traumatic event that leads to symptoms such as flashbacks that cause physical side effects, reoccurring memories or dreams, thoughts that are negative and distressing, avoidance of certain places, people, or experiences, insomnia, and depression to name a few. In some instances, drug or alcohol use develops as a response to these symptoms. A person may take different drugs in order to cope with these intense and stressful feelings, or alcohol may be used in order to self-medicate and find relief.

Substance Abuse and Co-Occurring PTSD
Substances Linked to

Co-Occurring PTSD

Though anyone can suffer from PTSD, several studies have found that women are more likely to seek treatment for PTSD as related to domestic or sexual violence, while men are more likely to seek help for combat related trauma. In both men and women, the rate at which a person struggles with co-occurring substance abuse is around 46.4%. Individuals dealing with both disorders at the same time often have worse outcomes and deal with more legal and psychiatric problems than others.


Co-morbid alcohol abuse and PTSD is a complicated condition because there is no one cause, no one indicator of future abuse, and no one treatment identified as 100% effective. In some cases, the use of alcohol precedes the PTSD and becomes worse after the trauma has been experienced. In other cases, PTSD leads to the development of an alcohol problem. Several studies have indicated across the board that an individual who suffers from any form of PTSD is at a severely increased risk for developing alcoholism, and there has also been conversation about the trauma that can often occur when an individual is under the influence of alcohol. 

When alcohol abuse occurs first, there is an increase of the risk that the individual will be exposed to some sort of trauma, whether that be physical or sexual. Approximately 74% of people who reported to struggling with problematic drinking also reported to having experienced some form of traumatic event. Despite these findings, other studies have suggested that the rate of co-occurring PTSD and alcohol use does not change regardless of which condition came first. Alcohol abuse was seen in anywhere from 10% to 61% of people with PTSD, and PTSD was seen in 2% to 63% of people struggling with alcohol use. 

Though we cannot definitively determine why these two conditions often occur together, inferences can be made. Alcohol is a central nervous system depressant that often relaxes people. Other effects can include increased sensations of euphoria, confusion, and blackouts. A person who has suffered intense trauma make seek solace in these effects, opting for that relaxation or even the blackouts as a way to cope with flashbacks, memories, or any other problems their PTSD causes. Unfortunately, these conditions create a vicious cycle that when left untreated could potentially be deadly.


Drug Use

Across the board, men and women who have suffered from traumatic events and deal with PTSD are at a higher risk for abusing drugs such as cociane or opioids. Just like with alcohol use, PTSD and drug use can cause one another and worsen the symptoms of one another. Though the strongest correlation indicates that PTSD usually precedes the development of drug abuse, studies have also found that people who participate in illicit drug use have a higher chance of ending up in a traumatic environment. 

One study found that of their participants who regularly used cocaine, 20.5% also met the DSM criteria for PTSD. Research has also shown that the use of psychoactive drugs is the highest in people with PTSD. Opioids are also often used as a form of self-medication, helping to alleviate physical or mental pain that these traumatic events may have caused. Studies have found that people with PTSD report higher ratings of pain and are prescribed opioids at a higher rate than people without PTSD.

PTSD Treatment

Treating Co-Occurring PTSD

The most difficult part of treating men and women with substance use disorders and co-occurring PTSD is that most people don’t seek treatment at all. Almost half of people who need help never actually get it, and because these conditions worsen one another, not seeking help can pose an extremely deadly threat. When it comes to addressing both conditions, it is critical that they are treated at the same time. Unfortunately, because each form of PTSD is different, it can be really difficult to determine what the best course of action is.

Some of the most effective types of treatment that are offered at dual diagnosis treatment centers include Seeking Safety groups, cognitive behavioral therapies, 12-step programs, cognitive restructuring, relapse prevention training, psychoeducation, and non-addictive medications. The most effective forms of care typically include a combination of several of these treatment types, and it is also critical to note that clients who seek help through a treatment facility have the best chance of recovering and living the rest of their life sober.

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